Risks Posed to Corneal Transplant Recipients by COVID-19-Affected Donors

Abstract

The recent emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its resultant human disease, COVID-19, will likely have a significant impact on the corneal tissue donor pool. Current recommendations from the United States and global eye bank associations call for the outright avoidance of tissues from donors recently infected with or exposed to COVID-19. This conservative recommendation is currently appropriate given the reported ocular sequelae, tear film viral detectability, and transmissibility of COVID-19. However, the rapidly increasing global prevalence and mortality of COVID-19 threatens the tenability of current tissue exclusion guidelines, and may necessitate their relaxation in the near future.

Corneal transplantation in the aftermath of the COVID-19 pandemic: an international perspective

“…In light of these uncertainties, guidelines (frequently updated) from major eye banks such as the Eye Bank Association of America (EBAA) and the Global Alliance of Eye Bank Associations (GAEBA) have recommended excluding donors recently infected with COVID-19, or those at high-risk such as a significant contact history— table 1 . 6 Though this is in line with US Food and Drug Administration (FDA) guidance on human cell, tissue and cellular or tissue-based products, the FDA guidelines further indicate that there is currently no evidence for transmission of respiratory viruses through tissue transplantation in general. 22 Moreover, corneal donors are usually double disinfected with povidone iodine before removal and preparation; and/or polyvinylpyrrolidone solution just before storage.…”

“…Furthermore, travel restrictions and curtailed elective procedures have led to the reduction in the supply, retrieval and demand for corneal transplantation. 6 Thus, the future of corneal transplantation faces an unprecedented threat, as access to this sight-restoring surgery is affected on a global scale. 7 Beyond the pandemic, COVID-19 may have lasting effects on corneal transplantation, as healthcare services resume to face long waiting lists and a potential shortage of donors.…”

Bedeutung der Hornhautorgankultur bei Spendern mit möglicher SARS-CoV-2-Infektion

“…Zur Klärung, ob eine korneale Infektion mit SARS-CoV-2 auftreten kann, sind weitere Untersuchungen zwingend notwendig. Es gibt bislang allenfalls Indizien, dass in Einzelfällen SARS-CoV-2 in der Kornea zu finden ist, diese Daten sind allerdings bislang wenig belastbar [15,16].…”

SARS-CoV-2: Impact on, Risk Assessment and Countermeasures in German Eye Banks

“…7 Meanwhile, similar debate has ensued among those involved in cornea and tissue banking, where potential hazards to staff and transplant recipients must be weighed against the ongoing need for tissue provision. 11 Decision-making is based on available data, which is limited but evolving. Specific guidelines from regulatory bodies and scientific boards have been made available (see Table 1) but evidence to support their theory is scarce.…”